Why Tuesday?

Tuesday, November 23, 2010

I am not a bitch. Contrary to popular opinion I am as nice a person as the next woman (that is if the next person is relatively pleasant).

As a doctor, I try my best to be somewhat level headed at all times. Sure I’m emotional (and somewhat self aware) but I try to maintain some sense of existential decorum.

However, once a month, my head splits and an emotional demon from hell emerges.

Yes, I’ll say it proud, dear girlfriends, I suffer (or rather those around me do most of the suffering) from Premenstrual Syndrome.

Don’t feel sorry for me, my cyber sisters. This is my plight and my permission. I really don’t need your pity- I am making my bitchiness work. Why just last week I felt the need amidst my Progesterone wrath to call American Express and unleash the “dogs of hell” over an error made to my list of charges. Rest assured my hormones did not go to waste, as only this week; I received an apology from the president and a $100 gift card for my troubles.

What good is a uterus if you can’t use it to buy shoes?

For those of you who don’t experience the “cycle of sad and hate” that is indeed the hallmark of any good lunar bitch-fest let me talk you through it…

Day one begins with a bang…. A crushing bang to the midsection, to be precise. This is where I feel like I have the flu AND I broke my pelvis all in one morning. The only thing keeping me positive throughout the mind numbing cramps is that the moodiness and anger of the preceding three to seven days can now justifiably end.

Five or so days later the glory of womanhood be gone and I can start wearing my good underwear again. I go about my daily life and almost forget that I have two ovaries and a uterus secretly plotting against me, like some evil stepsisters.

The days turn into weeks and before I know it, I start feeling a little sad. By day 24 this sadness has blossomed into an irrational flurry of emotions and I am crying at everything from a Disney preview to a Kleenex commercial.

Day 26 ushers in a wicked case of “veldtshmertz” (what the Germans would call world sadness) and I can no longer watch CNN or any news program for that matter. Suddenly, any world event has me reeling on the verge of an existential crisis.

Days 27 and 28 are spent with a full-blown case of the “bitchies” and if my beloved is reading this… I apologize for the 24 days a year he has had to endure said wrath over the last 16 years. When I sit down and do the math- that is collectively over a years supply of prime grade evil.

I will pick fights just to have them. I will make unholy requests of any relationship around me. Even more “untrue to form” is the fact that during this period of time, I develop an insane craving for all things deli and M&M pretzels.

Yes, dear sisters, me, the health freak spends 2 days a month fighting off the inner pull for chopped liver on rye and candied covered salt. It’s a world gone mad.

But it turns out; none of it is my fault…

A recent study presented at the American Society for Reproductive Medicine in Denver, Colorado in October, 2009 shows that the women’s’ brains are significantly affected at various stages of the menstrual cycle.

The study took MRI’s of more than two dozen women while they were looking at different pictures and had them rate the photos as pleasant, unpleasant or neutral. The same photos were shown to all women at different stages during their cycle.

At each instance an MRI was taken of their brains while they were viewing the photos.

In the early stage of the menstrual cycle (called the follicular phase- my days 7-12), no areas of the women's brains showed significantly increased activation while viewing the pictures.

During the midpoint of their menstrual cycle, when hormone levels were higher, the women had increased activity in the lateral prefrontal cortex and other areas of the brain involved in processing emotional information, the researchers found.

By the later phases of the cycle (days 20-28) the activity in the lateral prefrontal cortex was at its highest.

The prefrontal cortex plays a huge role in goal oriented behaviour and emotional response.

The fact that this study shows a correlation between hormonal levels and certain activity is no surprise to most women out there.

Who among us has not felt freaking crazy during the later parts of our monthly cycle??

Previous studies have found that the rate of affective disorders (mood disorders) is two times higher in women than in men. Many experts believe this difference is from sex hormones. Perhaps there is some truth to this, but further studies need to be held before we can blame our “girly parts” for all things crazy.

SO science wins again! I am not a bitch…. It’s just my prefrontal cortex in a bad episode of GIRLS GONE WILD. Whatever will I do?

For now, I’ll count out my life in teaspoons of hormones to paraphrase T.S. Eliot. I’m sure he suffered from a great deal of sadness. If only the dude had a uterus…. He’d have someone to share the responsibility.

Tuesday, November 16, 2010

Do you remember when you were little and you had a nightmare? When you woke from sleep with a start and the room was dark and the world was terribly frightening and the fear tasted like a metal popsicle at the back of your throat? And all you could do was run to your parents bedroom and ask to be allowed into bed?

There I was at five or six or even eight years old, standing at the foot of my parents bed at some unholy hour with my feet digging into the shag carpet hoping that they would wake up to my whispers….

“Mommy?” I said in a whimper, “I’ve had a bad dream. Can I sleep with you and Dad?” There it was. A plea and a prayer. Please let her not banish me back to my own bedroom where God knows what freak of my imagination was waiting to cut me up.

It was the 1970’s girlfriends. Horror movies were a whole different genre. We’re talking Friday the 13th, part one, Halloween, part one and Steven King before he has a family and antidepressants. These were frightening times.

I think one of the older kids in the neighbourhood had convinced me to see Carrie the night before and my subconscious had feasted on blood and terror while I snacked on licorice. Between the sugar high and the jarring scenes, I was just ordering the perfect slumbertime scare straight off the menu.

As a professional multitasker, I am die hard fan of the power of the subconscious. I love it that while my body sleeps, my brain tries to make sense of the previous days’ events. It seems like a very efficient way to work through ones psychological baggage.

Why just last week I had the most amazing dream. Having spent the evening watching web casts of the spring fashion shows on Style.com, I had the pleasure of dreaming that I was in a Chanel fashion show.

Let’s be clear, I have neither the hips nor the bank account to support anything Chanel has to offer, but in my dream it did not matter. I met Karl Lagerfeldt and he told me in perfect French (yes, in my dream, I was fluent) that I was his new muse. LOVE IT!

But then there are the nights when I’m a little too tired or a little too stressed and I make the mistake of watching a little too much HBO before bedtime. And before I know it, it’s three in the morning and I’ve woken from a really shitty dream. I empty my bladder and try and recollect myself as I fall back into bed and try not to think too much so that I can be back asleep before I know it.

The eight year old in me is alive and well. And now I crawl back into bed with my boy and snuggle into him. My pups fall into line; one next to my head and the other curls up by my side. I listen to everyone snore and try to sync my breathing with theirs and pretty soon, before I know it, it’s morning.

Overall, half of adults experience nightmares - women twice as often as men. Studies show that we start having nightmares around the age of five. Children ages 5-15 have on average one nightmare per week. The frequency of this drops off after the age of 25. Between the ages of 25 and 50, 25-50% of people have about one nightmare per month.

The cause of nightmares remains unclear. However, previous research suggests that stress may play a key role and that nightmares may actually serve a beneficial function. A study published in DREAMING in 2002 examined the overall relationship between stress and frequency of nightmares. The study’s hypothesis was that nightmares in fact may serve as a coping mechanism for stress.

The study looked at a group of 412 psychology students with low, medium, and high nightmare frequency. The students were separated into one of three groups according to nightmare frequency as well as low, medium, and high nightmare intensity groups.

Comparisons were then conducted for daily stressors, life stressors, social support, and coping. Most notably, this study demonstrated a positive association between nightmares and coping with stress.

The group with the highest coping mechanism had the highest frequency of nightmares, suggesting that nightmares may be a mechanism to alleviate stress.

One of the questions the study could have answered was whether people who develop better coping mechanisms actually develop more nightmares? In other words, can your frequency of nightmares reflect your ability to cope with stress as well? As you get better with stress, do the nightmares decrease?

Studies show that alcohol consumption and certain medication as well as certain foods (those with higher sugar content) can increase the incidence of nightmares. Further studies have suggested that people with increased frequency of nightmares may have residual effects of feeling anxious the day after the actual bad dream.

SO there you have it. I’m working out my life’s problems through my freaky dreams. Maybe I am a bit bitchier on the morning after, maybe not; A small price to pay to working out life’s challenges. As for me, a margharita and HBO before bed tend to increase the risk of a “bad ass” dream. Some herbal tea and a good fashion magazine and I am guaranteed a good night’s rest and a fantasy walk in Paris fashion week.

Monday, November 8, 2010

My mother has perfect skin. If she is reading this right now she is undoubtedly touching her face. At seventy she has a few wrinkles (what woman without Botox doesn't?) but she has this perfect creamy white skin that is as soft as can be. My mother does not deserve her perfect skin. Make no mistake- she's a lovely woman; a saint in fact. But she washes her face with.... wait for it.... Dove soap and water. This is not a product placement, this is a fact. She has not used moisturizer on her face as long as I have known her.

Perhaps she avoided the sun in her youth and no she never smoked. But she does not adhere to a special diet. The woman keeps mini York peppermint patties in her purse (again no product placement, just fact) and a Jeannie's Cake (Winnipeg's famously beloved birthday cake) in her freezer at all times.

As her daughter, I thought some of these kick ass skin genes would cross the womb, so to speak. As a teenager, I used Mama's tried and true Dove soap and water. I was relatively unscathed in the acne department.

Sure once a month my face broke around the time I became an irrational evil person but things would settle down and my skin was none the wiser.

Now on the verge of 40 (how many blogs will I mention the fast approaching four-oh?) I have developed adult onset acne.

Prior to writing this I spent a good fifteen minutes staring at my pores in one of those bastard close up hotel bathroom mirrors. These mirrors really are assholes. Firstly, they are undoubtedly placed in a location in a hotel bathroom that involves several yoga classes and unrealistic core muscles in order to view your pores properly.

Let’s be clear- I’ve been training to climb a mountain and so I am physically better prepared to stand in my underwear crouching tiger over a mirror and a sink arms poised in assault on any blackhead that dare to show its… well its head. And now, fully stretched across said sink, I am looking into a mirror that has magnified my face 20 fold when it dawns on me that perhaps nothing, not even one’s skin should be viewed at such a magnification.

Were we ever meant to see any part of our body “up that close”? Or is this yet another contraption made by some marketing bitch that serves only to make you feel both fascinated and ashamed at the state of your current physiological affairs.

So hear I am fumbling towards forty and Rather than wrinkles, I’m facing a state of acne that only a teenager could really sympathize with. Good news is, my middle age has afforded me just enough apathy and neuroses to make the current state of my skin fill me with a mixed bag of emotion.

Part of me could not care less. I have the means to buy the really good cover up and a sample cupboard at my office to provide me with enough pharmaceutical grade acne creams that would make the teenage version of myself swoon.

The other part of me is just neurotic enough to wonder how long will this dermis rebellion last. Am I the girl who is going to have zits instead of crows feet? Or worse yet? Both?

I had long come to terms with my looks somewhere after age 35 when I learned that anything can be beautiful with the right pair of footwear. That being said… when your red spotted face matches your red soled shoes… life gets rather complicated.

A study published in the American Journal of Dermatology show that I am not so alone with my face up against a cruel and judgmental bathroom mirror....

The study looked 749 people over the age of 25 as a community-based study to investigate the current prevalence of facial acne in adults.

The group of people were examined at random and found that some degree of facial acne was recorded in 231 women and 130 men, giving an overall prevalence in women and 40% in men. The prevalence of acne did not substantially decrease until after the age of 44 years in this patient population.

A further study published in 1998 in the British Journal the showed that the rate of the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years.

In this study the prevalence of adult acne in women was significantly higher at 76% of women and 24% of men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 18.4% of women and 8.3% of men.

Thirty-seven per cent of women with adult onset acne had features of hyperandrogenicity ( increased testosterone) with other clinical features like male pattern hair growth (see my previous rants about my mustache) This may be an indicator of other disease states in some women including polycystic ovary disease.

External factors, such as cosmetics. drugs and occupation, were not found to be significant causal factor. A family history revealed that 50% of patients had a first-degree relative with post-adolescent acne.

So... Here I am in another hotel room bathroom mining my black heads with the pride of a Chilean miner. My mother's Dove (soap) has long flown the coop and I know spend far too much on facial promises that make promises they can not nor will not keep.

I have resorted to flirting shamelessly with the drug reps who frequent my office pedaling their high grade pharmaceutical facial creams in the hope that one day.... I will have Mama's dermatological legacy.

According to the evidence my skin should improve in the next 5 or so years..... Just about the time the wrinkles fully take hold.

Until then, If you need me, I'll be in the bathroom crouching tiger, hidden dragon over a magnifying mirror. It may do nothing for my face but my character and my abdominal muscles have never been stronger.

Tuesday, November 2, 2010

The power of music has always fascinated me. As a kid I can remember standing in front of my living room window and performing the entire score to the Broadway musical Woman of the Year on a regular basis.

It was more than a make-believe moment for me. Some kids played sports after school, others road their bikes in the street. I stood in front of a living room bay window and played “musical theatre” all on my own. I would put a tape into our cassette recorder and belt out the score for the entire front yard to see and hear.

Let’s be clear…. This was the 1970’s. Musical theatre was still relatively underground among eight year olds. I memorized all the parts to “A Chorus Line” well before it was cool.

In 1979, my parents went to New York City and brought me back the soundtrack to “Woman of the Year” starring Ms. Lauren Bacall. I fell in love with her before the end of the opening number. I sang the part of Tess so many times that to this day I have the words emblazoned on my brain. My living room was host to easily 120 performances of “Woman of the Year” with yours truly bringing down the house each night.

I played the damn thing so much, I warped the tape. For those of your reading this who have no idea what a tape cassette is, safe to say, that’s a lot of times.

It was not just musical theatre that caught my musical attention. I remember playing 33’s of Journey, Air Supply and Trooper and singing along as though I was the world’s greatest groupie. From Mr. Roboto to the Boys in the Bright White Sports Car, I memorized every note and every lyric.

I sang into a hairbrush, a curling iron or a can of hairspray. I was my own rock star.

In my teenage years, the tapes moved into CD’s. Stacks of the things filled my life like little towers of tunage in various combinations around my bedroom.

Then there was the MIX TAPE. Remember the MIX TAPE? That one perfectly crafted combination of tunes of all shapes and sizes put onto one tape/CD as the ultimate measure of self expression. Who you were in life was who you were on a MIX TAPE. Want to tell someone you think they are THE ULTIMATE? Say it with the perfect combination of Peter Gabriel, Stevie Nicks and some Supertramp. No need to say what you feel.... put it in a MIX TAPE. Wrap it up with a home made cover page and you have yourself the ultimate piece of self-expression.

Every mix tape I made was inevitably called "A to Z SPECIAL MIX" I thought I was being so clever.

My twenties saw the birth (and death) of Napster and the digital music movement. I sang my way through it all. In my head I sounded like Beyonce. In reality, I carried a tune across the bedroom and just barely made it.

I’m not a bad singer (there’s a healthy sense of self esteem) but I’m not a good one. How shall I put this? If I auditioned on American Idol, I WOULD NOT make it to Hollywood, however, there would also NOT be a You-Tube video of me singing some sort of freaky rendition of “Poker Face”. Nuff said.

But I do love my music. I like the beat of anything, the rhythm that fills up your brain and instantly puts you in a better mood.

Even at this moment I am listening to my latest I-Tunes download (yes I paid for it, thank you very much) and tapping my heels while I pen this little bit of magic.

Of course I am sitting in a café and mouthing the words to Eminem’s “Not Afraid”. Those around me likely think I am some sort of psychotic writer. I like to think of myself as “creative”.

A study presented in New Orleans at the American College of Cardiology Annual meeting in 2008 showed that my mp3 player might be on to something.

Ten healthy, non-smoking volunteers participated in all phases of the randomized study. There were four phases. In one, volunteers listened to music they selected that evoked joy. The volunteers brought recordings of their favorite music to the laboratory. Another phase included listening to a type of music that the volunteers said made them feel anxious. In a third session, audiotapes to promote relaxation were played and in a fourth, participants were shown videotapes designed to induce laughter.

Each volunteer participated in each of the four phases, but the order in which each phase occurred was determined at random.Prior to each phase of the study, the volunteers fasted overnight and were given a baseline test to measure what is known as flow-mediated dilation.

This test can be used to determine how the endothelium (the lining of blood vessels) responds to a wide range of stimuli, from exercise to emotions to medications.

The theory behind this is that the endothelium has a powerful effect on blood vessel tone and regulates blood flow. It also plays an important role in the development of cardiovascular disease.

After the baseline test, each volunteer was exposed to the music or humorous video for 30 minutes. Their endothelial function (or “stretchiness”) was measured periodically during each phase of the test.

In other words, they were listening to Madonna and having their endothelial function measured. Additional dilation measurements were obtained throughout each phase to assess changes from baseline. Compared to baseline, the average upper arm blood vessel diameter increased 26 percent after the joyful music phase, while listening to music that caused anxiety narrowed blood vessels by six percent.

During the laughter phase of the study, a 19 percent increase in dilation showed a significant trend. The relaxation phase increased dilation by 11 percent on average.

Further studies have shown that music therapy can be beneficial for patients undergoing chronic treatments such as chemotherapy or dialysis.

So there you have it.

Right and left brain unite. Strike up the band…. And cue music please. If you need me, I’ll be in my shoe closet lip-syncing for head AND heart’s sake.

About Me

Dr. Ali Zentner received her undergraduate medical degree from McMaster University and completed her Internal Medicine Residency with an extra year of Cardiology training at the University of Calgary. Ali has been practicing Internal Medicine since 2001 as a specialist in Cardiac Risk Management and Obesity. Ali is the author of The Weight Loss Prescription, published by Penguin books in 2013. It is the ultimate guide for healthy living and one hell of a book (no bias here). Ali also wrote A Good Life, a work of fiction, published in 2003. The novel has been best described as “Sex in the City” meets “ER” and details one woman’s struggle to find meaning in a world not always under her control. Both books are available on amazon.com. A classic overachiever, Dr. Zentner has completed the Vancouver marathon, and half marathons in New York, Vancouver and Toronto. She is an avid swimmer, runner and cyclist training for her next triathlon and who exercises to keep fit and to justify her next fashion purchase. She lives in Vancouver with her husband who says nothing about the size of his wife’s shoe closet (if he knows what is good for him)…